Provider Demographics
NPI:1235630500
Name:NORTHWEST PHYSICAL THERAPY AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:NORTHWEST PHYSICAL THERAPY AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-294-0612
Mailing Address - Street 1:93 OLD YORK RD STE 1-756
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3925
Mailing Address - Country:US
Mailing Address - Phone:215-294-0612
Mailing Address - Fax:
Practice Address - Street 1:7618 OGONTZ AVE FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1817
Practice Address - Country:US
Practice Address - Phone:215-224-1494
Practice Address - Fax:215-224-1495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty